Crisis Lines: Current Status and Recommendations for Research and Policy

Speech based suicide risk recognition for crisis intervention hotlines using explainable multi-task learning

BACKGROUND

Crisis Intervention Hotline can effectively reduce suicide risk, but suffer from low connectivity rates and untimely crisis response. By integrating speech signals and deep learning to assist in crisis assessment, it is expected to enhanced the effectiveness of crisis intervention hotlines.

METHODS

In this study, a crisis intervention hotline suicide risk speech dataset was constructed, and the speech was labeled based on the Modified Suicide Risk Scale. On the dataset, the variability of speech duration between different callers and different speech high-level features were explored across callers. Finally, this study proposed a data-theoretically dual-driven, gender-assisted speech crisis recognition method based on multi-tasking and deep learning, and the results of the model were obtained through five-fold cross-validation.

RESULTS

Analysis of the dataset demonstrated gender differences in callers, with male callers speaking more in crisis calls compared to females. Feature analysis revealed significant differences between crisis callers in terms of emotional intensity of speech, speech rate and texture. The proposed method outperformed other methods with an F1 score of 96 % on the validation data, and feature visualization of the model also demonstrated the validity of the method.

LIMITATIONS

The sample size of this study was limited and ignored information from other modalities.

CONCLUSION

These findings demonstrated the effectiveness of the proposed model in speech crisis recognition, and the statistical data analysis enhanced the Interpretability of the model, while showing that the integration of data and theoretical knowledge facilitates the effectiveness of the method.

Demographic and Clinical Characteristics of Mental Health Crisis Line Callers Who Were Transferred to 911

OBJECTIVE

This study aimed to describe the characteristics of callers to a statewide mental health crisis line who were transferred to 911 (active rescue).

METHODS

This retrospective cohort study examined mental health crisis line calls transferred to active rescue (N=3,538 calls; N=3,132 unique callers) from the Georgia Crisis and Access Line (2016-2018). Chi-square analyses and t tests were used to examine descriptive differences between caller characteristics and call features.

RESULTS

Of crisis line callers with a contact that resulted in active rescue, 53% were male, and 53% were Black. Youth callers represented 11% of all rescue calls; 74% of these callers had Medicaid. Active rescue most frequently occurred because of a danger to oneself (58%). Reasons for active rescue differed by race (p<0.001).

CONCLUSIONS

Most crisis calls resulting in active rescue occurred because of concern about self-harm. Demographic differences by reason for active rescue reveal gaps in the understanding of crisis care delivery.

Enhancing Equity on Crisis Lines: Understanding the Background, Practices and Learning Needs of Responders in Canada

Understanding the current state of equity, diversity, and inclusion (EDI) within the crisis line sector is essential to enhancing accessibility and acceptability of crisis line services for all. Through an intersectional lens, we examined 9-8-8 crisis line workers' personal and work demographics, training, resources, perceived competencies in supporting diverse populations. We conducted an electronic survey of crisis line responders and leadership in Canada. Data was analyzed using descriptive statistics, Fisher's test, and Mann-Whitney U/Kruskal-Wallis H tests. Open ended responses were analyzed using content analysis. 323 surveys were completed. Analysis revealed statistically significant associations between respondent demographics, training satisfaction, access to resources, and perceived competency in supporting diverse communities. Conclusion: The findings indicate the need for new approaches to recruitment and training in the crisis line sector to enhance the inclusivity of crisis services for all individuals seeking mental health support.

Is access to crisis teams associated with changes in behavioral health mortality?

Behavioral health-related mortality-deaths from suicide, drug overdose, and acute alcohol injury-are leading causes of death among US adults. Crisis teams, trained behavioral health professionals who serve as first responders to assess and stabilize clients in crisis, as well as refer to treatment as necessary, have been shown to reduce psychiatric hospitalizations, but whether crisis teams reduce behavioral health mortality has not been studied. We assessed the association between changes in access to crisis team programs and changes in county-level suicide, drug overdose, and acute alcohol injury mortality from 2014 through 2019. We found that 250 (9%) of counties experienced crisis team program entry and another 237 (9%) experienced crisis team program closure. Access to crisis team programs was associated with significant changes in county-level drug overdose deaths, but not suicide or acute alcohol injury. Compared with counties with no change in access, crisis team program entry was associated with a 7% reduction in county-level drug overdose death rates, and crisis team program closure was associated with a 13% increase in drug overdose death rates. These findings may support the use of crisis teams as 1 intervention to address substance use disorder treatment gaps in the United States.

"They pulled that funding away and we're not recovering. it's getting worse": deaths of despair in post-austerity north east England

BACKGROUND

Deaths related to suicide, drug misuse, and alcohol-specific causes, known collectively as "deaths of despair" are of growing interest to researchers in England. Rates of death from these causes are highest in deprived northern communities and are closely tied to the social determinants of health and the policy decisions that have shaped them. The aim of this paper is to explore how stakeholders and community members living in Middlesbrough and South Tyneside, two Northern towns with above average rates of deaths of despair, understood the relationship between austerity policies and rates of deaths from these causes in their areas.

METHODS

I conducted interviews and one focus group with a total of 54 stakeholders and community members in Middlesbrough and South Tyneside. Data were analysed using the iterative categorisation technique and the findings were interpreted through thematic analysis.

RESULTS

The findings highlight four primary ways through which austerity exacerbated rates of deaths of despair in Middlesbrough and South Tyneside: reduced access to mental health services, diminished substance abuse treatment capacity, loss of youth services, and the closure of community institutions. Participants linked these cuts to rising social isolation, declining mental health, and increased substance misuse, which collectively deepened geographic inequalities in deaths of despair.

CONCLUSIONS

This study underscores the urgent need for reinvestment in local services to reduce inequalities and prevent further unnecessary deaths due to drug, suicide, and alcohol-specific causes. Prioritising the restoration and enhancement of services lost to austerity is critical. Such reinvestment will not only help to alleviate some of the most immediate need but also form a foundation for addressing the wider structural inequalities that perpetuate deaths of despair.

Follow-Up Care Offers and Acceptance in Crisis Line Suicide Prevention Services

Background: Prior work has explored the impact of follow-up calls in a crisis line context, but no research has investigated the offer and acceptance of follow-up care. Aims: To identify caller/call characteristics associated with whether a caller is offered and accepts follow-up services. Methods: This cross-sectional study included data from 55,594 callers to a member center of the 988 Suicide & Crisis Lifeline (988) between 2017 and 2019. Logistic regression analyses were conducted to examine associations between caller/call characteristics and two follow-up outcomes. Results: Black callers and those with higher suicide capability and intent had greater odds of being offered and accepting follow-up. Longer call duration was also associated with higher odds of being offered and accepting follow-up. Higher suicidal desire uniquely increased the odds of offers, whereas a higher level of buffers uniquely decreased the odds of offers. Limitations: Data were collected from a single 988-member center and cannot be generalized. Conclusions: That one-third of callers do not accept follow-up highlights the need to understand reasons for not accepting follow-up. That callers with higher risk profiles are offered and accept follow-up at higher rates is reassuring and underscores the benefit of tailoring follow-up interventions for higher-risk callers.

Making Decisions About Calling 988 Versus 911: Understanding End-User Views Before the Launch of 988

OBJECTIVE

The 988 telephone number was implemented in July 2022 as an easily accessible way to reach the National Suicide Prevention Lifeline and has been envisioned as one step in building a more robust crisis care continuum in the United States. This study aimed to describe how various stakeholders anticipated using 988 compared with the most widely known crisis line: 911.

METHODS

Focus groups (N=15, with 76 total participants) were conducted in three counties in New York State between October and November 2021, before the launch of 988. Five stakeholder groups were included: mental health services consumers, family members of consumers, community members, mental health providers, and crisis call takers. Thematic analysis was used to code and analyze all focus group transcripts.

RESULTS

Participants anticipated that key uses for 988 would be accessing support during a crisis, obtaining connections to local resources and services, and receiving alternatives to law enforcement response. However, participants continued to articulate uses for 911 during a mental health crisis, especially for situations involving "safety concerns."

CONCLUSIONS

The broad expectations for 988 suggest that the line must be flexible and responsive to a range of needs and that communities should clearly define what is available through 988. More implementation research is needed to ensure a detailed understanding of those whom 988 is serving, how the line meets callers' needs, and the line's potential for connecting people to needed services.

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences

Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.

Evaluation of the Effectiveness of Suicide.ca, Quebec's Digital Suicide Prevention Strategy Platform: Cross-Sectional Descriptive Study

BACKGROUND

In 2017, the Quebec government assigned the Association québécoise de prévention du suicide (AQPS) to develop a digital suicide prevention strategy (DSPS). The AQPS responded by creating a centralized website that provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text.

OBJECTIVE

This study aims to evaluate the effectiveness of suicide.ca, Quebec's DSPS platform.

METHODS

This study used a cross-sectional descriptive design. The study population comprised internet users from Quebec, Canada, who visited the suicide.ca platform between October 2020 and October 2021. Various data sources, such as Google Analytics, Firebase Console, and Customer Relation Management data, were analyzed to document the use of the platform. To understand the profile of suicide.ca users, frequency analyses were conducted using data from the self-assessment module questionnaires, the intervention service's triage questionnaire, and the counselors' intervention reports. The effectiveness of the platform's promotional activities on social media was assessed by examining traffic peaks. Google Analytics was used to evaluate the effectiveness of AQPS' strategy for identifying at-risk internet users. The impact of the intervention service was evaluated through an analysis of counselors' intervention reports and postintervention survey results.

RESULTS

The platform received traffic from a diverse range of sources, with promotional efforts on social media directly contributing to the increased traffic. The requirement of a user account posed a barrier to the use of the mobile app, and a triage question that involved personal information led to a substantial number of dropouts during the intervention service triage. AdWords campaigns and fact sheets addressing suicide risk factors played a crucial role in driving traffic to the platform. With regard to the profile of suicide.ca users, the findings revealed that the platform engaged individuals with diverse levels of suicidal risk. Notably, users of the chat service displayed a higher suicide risk than those who used the self-assessment module. Crisis chat counselors reported a positive impact on approximately half of the contacts, and overall, intervention service users expressed satisfaction with the support they received.

CONCLUSIONS

A centralized digital platform can be used to implement a DSPS, effectively reaching the general population, individuals with risk factors for suicide, and those facing suicidal issues.

Association of Arizona's Implementation of a Behavioral Health Crisis Response System With Suicide Hospitalizations

OBJECTIVE

In July 2022, the 988 Suicide and Crisis Lifeline went live. The Lifeline is part of larger federal and state efforts to build comprehensive behavioral health crisis response systems that include mobile crisis units and crisis diversion and stabilization centers. Comprehensive response systems are anticipated to reduce hospitalizations for suicide and other behavioral health crises; however, research testing this assumption has been limited. The authors used Arizona-a state known for its comprehensive crisis system-to determine the association between state implementation of a comprehensive behavioral health crisis response system and suicide-related hospitalizations.

METHODS

A comparative interrupted time-series (CITS) design was used to compare changes in suicide-related hospitalizations after the 2015 implementation of Arizona's crisis response system (N=215,063). Data were from the 2010-2019 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Nevada (N=84,091 hospitalizations) was used as a comparison state because it is a western state that had not yet implemented a comprehensive crisis system and had available HCUP SID data. The CITS model included controls for time-varying differences in state demographic composition.

RESULTS

From 2010 to 2014 to 2019, annual suicide-related hospitalizations in Arizona increased from 122.0 to 324.2 to 584.5, respectively, per 100,000 people, and in Nevada, hospitalizations increased from 94.7 to 263.2 to 595.5, respectively, per 100,000 people. Arizona's crisis response system was associated with a significant relative decrease in the quarterly trend of 2.57 suicide-related hospitalizations per 100,000 people (p=0.033).

CONCLUSIONS

More research is needed to understand how the implementation of a comprehensive crisis response system may affect suicide-related hospitalizations.